入院早期PCT、NLR、Lac对脓毒症患者病情分级及预后预测的价值

The value of PCT,NLR and Lac in predicting the disease grade and prognosis of sepsis patients at early admission

目的 探究入院早期降钙素原(PCT)、中性粒细胞/淋巴细胞比值(NLR)、乳酸(Lac)对于脓毒症患者病情判断及预后预测的价值。方法 选取绵阳市中心医院2020年10月至2022年10月收治的128例脓毒症患者,按脓毒症标准分级分为轻症组(n=52)、严重组(n=49)及休克组(n=27)。比较三组脓毒症患者血清中肿瘤坏死因子α(TNF-α)、白细胞介素-6(IL-6)及PCT、NLR、Lac的水平;比较三组患者序贯器官功能衰竭(SOFA)评分;使用多因素logistic回归分析影响脓毒症患者预后的独立危险因素;通过受试者工作特征曲线(ROC)分析血清中PCT、NLR、Lac水平对于脓毒症患者预后的诊断价值。结果 三组脓毒症患者血清中炎症因子TNF-α、IL-6及PCT、NLR、Lac的水平呈休克组>严重组>轻症组,差异有统计学意义(F=3.927,3.543,6.050,5.809,4.278,P<0.05);多因素logistic回归分析显示,血清TNF-α、IL-6、PCT、NLR、Lac水平升高是脓毒症患者预后死亡的独立危险因素(P<0.05);ROC曲线显示,血清PCT、NLR、Lac及三者联合预测脓毒症预后的曲线下面积(AUC)分别为0.790、0.664、0.720,0.961,三者联合预测效果更加显著(P<0.05)。结论 入院早期脓毒症患者血清中,PCT、NLR、Lac的表达异常,且均是患者预后的独立危险因素;PCT、NLR、Lac及三者联合对脓毒症患者的预后预测有一定价值,可临床上推广应用。

Objective To explore the value of procalcitonin(PCT),neutrophil/lymphocyte ratio(NLR)and lactic acid(Lac)in the diagnosis and prognosis of sepsis patients at early admission.Methods A total of 128 patients with sepsis admitted to Mianyang Central Hospital from October 2020 to October 2022 were selected and divided into the mild group(n=52),the severe group(n=49)and the shock group(n=27)according to the standard classification of sepsis.The serum levels of tumor necrosis factorα(TNF-α),interleukin-6(IL-6),PCT,NLR and Lac were compared among three groups of sepsis patients.Sequential organ failure(SOFA)scores were compared among the three groups.Multivariate logistic regression was used to analyze the independent risk factors affecting the prognosis of patients with sepsis.The diagnostic value of serum PCT,NLR and Lac levels for the prognosis of sepsis patients was analyzed by the receiver operating characteristic curve(ROC).Results The serum levels of inflammatory factors TNF-α,IL-6,PCT,NLR and Lac in three groups of sepsis patients were higher in the shock group than in the severe group than in the mild group,and the differences were statistically significant(F=3.927,3.543,6.050,5.809,4.278,P<0.05).Multivariate logistic regression analysis showed that increased serum levels of TNF-α,IL-6,PCT,NLR and Lac were independent risk factors for prognostic death in sepsis patients(P<0.05).The ROC curve showed that the area under the curve(AUC)of serum PCT,NLR,Lac and their combined prediction of sepsis prognosis were 0.790,0.664,0.720 and 0.961,respectively,and the combined prediction effect of the three was more significant(P<0.05).Conclusion The abnormal expression of PCT,NLR,and Lac in the serum of patients with sepsis in the early stage of hospitalization is an independent risk factor for the prognosis of patients;PCT,NLR,Lac,and their combination have certain value in predicting the prognosis of sepsis patients and can be widely applied in clinical practice.